Intest Res.  2020 Oct;18(4):438-446. 10.5217/ir.2019.00090.

Advanced neoplasia detection using chromoendoscopy and white light colonoscopy for surveillance in patients with inflammatory bowel disease

• Kim KO
• Chiorean MV

• KMID: 2508575
• DOI: http://doi.org/10.5217/ir.2019.00090

Abstract

Background/Aims
Chromoendoscopy (CE) has been shown to be superior to white light endoscopy (WLE) for neoplasia detection in inflammatory bowel disease (IBD). We aimed to compare the yield of CE and WLE for the detection of overall neoplasia and advanced neoplasia in IBD.
Methods
Patients who underwent surveillance colonoscopy from 1999 to 2017 were identified from our IBD database. CE procedures were compared with their respective WLE controls in a paired comparison, and frequency of all neoplasia, advanced neoplasia, and serrated neoplasia was assessed for both targeted and random biopsies.
Results
A total of 290 procedures performed in 98 individuals were identified with a median follow-up 4 years (median 3 colonoscopies/patient). CE and WLE were performed in 159 and 131 episodes, respectively. CE detected neoplasia in 40.9% of colonoscopies versus 23.7% with WLE (P= 0.002). In addition, CE detected more advanced neoplasia (18.2% vs. 6.1%, P= 0.002) and serrated lesions (14.5% vs. 6.1%, P= 0.022). Significantly fewer samples were obtained per procedure with CE (14.9 ± 9.7 vs. 20.9 ± 11.1, P< 0.001). Cancer was diagnosed in 2 cases.
Conclusions
CE has a higher detection rate than WLE for advanced neoplasia and serrated lesions in patients with IBD under surveillance. Further prospective studies evaluating the impact of CE on decreasing the risk of interval cancer and colectomy in IBD patients are warranted.

Keyword

Image enhancement; Colorectal neoplasms; Inflammatory bowel disease

Reference

1. Kim ES. Role of advanced endoscopic imaging techniques in the management of inflammatory bowel disease. Clin Endosc. 2017; 50:424–428.

2. Ekbom A, Helmick C, Zack M, Adami HO. Ulcerative colitis and colorectal cancer: a population-based study. N Engl J Med. 1990; 323:1228–1233.

3. Ekbom A, Helmick C, Zack M, Adami HO. Increased risk of large-bowel cancer in Crohn’s disease with colonic involvement. Lancet. 1990; 336:357–359.

4. Colman RJ, Rubin DT. Histological inflammation increases the risk of colorectal neoplasia in ulcerative colitis: a systematic review. Intest Res. 2016; 14:202–210.

5. Thomas T, Abrams KA, Robinson RJ, Mayberry JF. Meta-analysis: cancer risk of low-grade dysplasia in chronic ulcerative colitis. Aliment Pharmacol Ther. 2007; 25:657–668.

6. Farraye FA, Odze RD, Eaden J, et al. AGA medical position statement on the diagnosis and management of colorectal neoplasia in inflammatory bowel disease. Gastroenterology. 2010; 138:738–745.

7. Laine L, Kaltenbach T, Barkun A, et al. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastrointest Endosc. 2015; 81:489–501.

8. Cairns SR, Scholefield JH, Steele RJ, et al. Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002). Gut. 2010; 59:666–689.

9. Magro F, Gionchetti P, Eliakim R, et al. Third European evidencebased consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis. 2017; 11:649–670.

10. Shanahan F, Quera R. CON: surveillance for ulcerative colitisassociated cancer: time to change the endoscopy and the microscopy. Am J Gastroenterol. 2004; 99:1633–1636.

11. Fujii S, Fujimori T, Chiba T, Terano A. Efficacy of surveillance and molecular markers for detection of ulcerative colitis-associated colorectal neoplasia. J Gastroenterol. 2003; 38:1117–1125.

12. Itzkowitz SH, Harpaz N. Diagnosis and management of dysplasia in patients with inflammatory bowel diseases. Gastroenterology. 2004; 126:1634–1648.

13. van den Broek FJ, Stokkers PC, Reitsma JB, et al. Random biopsies taken during colonoscopic surveillance of patients with longstanding ulcerative colitis: low yield and absence of clinical consequences. Am J Gastroenterol. 2014; 109:715–722.

14. Rutter MD, Saunders BP, Schofield G, Forbes A, Price AB, Talbot IC. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis. Gut. 2004; 53:256–260.

15. Kiesslich R, Fritsch J, Holtmann M, et al. Methylene blue-aided chromoendoscopy for the detection of intraepithelial neoplasia and colon cancer in ulcerative colitis. Gastroenterology. 2003; 124:880–888.

16. Marion JF, Waye JD, Present DH, et al. Chromoendoscopy-targeted biopsies are superior to standard colonoscopic surveillance for detecting dysplasia in inflammatory bowel disease patients: a prospective endoscopic trial. Am J Gastroenterol. 2008; 103:2342–2349.

17. Kiesslich R, Goetz M, Lammersdorf K, et al. Chromoscopyguided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology. 2007; 132:874–882.

18. Konijeti GG, Shrime MG, Ananthakrishnan AN, Chan AT. Costeffectiveness analysis of chromoendoscopy for colorectal cancer surveillance in patients with ulcerative colitis. Gastrointest Endosc. 2014; 79:455–465.

19. ASGE Technology Committee, Wong Kee Song LM, Adler DG, et al. Chromoendoscopy. Gastrointest Endosc. 2007; 66:639–649.

20. Mooiweer E, van der Meulen-de Jong AE, Ponsioen CY, et al. Chromoendoscopy for surveillance in inflammatory bowel disease does not increase neoplasia detection compared with conventional colonoscopy with random biopsies: results from a large retrospective study. Am J Gastroenterol. 2015; 110:1014–1021.

21. Jackson WE, Achkar JP, Macaron C, et al. The significance of sessile serrated polyps in inflammatory bowel disease. Inflamm Bowel Dis. 2016; 22:2213–2220.

22. Polydorides AD, Harpaz N. Serrated lesions in inflammatory bowel disease. Gastrointest Endosc. 2017; 85:461.

23. Shen J, Gibson JA, Schulte S, et al. Clinical, pathologic, and outcome study of hyperplastic and sessile serrated polyps in inflammatory bowel disease. Hum Pathol. 2015; 46:1548–1556.

24. Dignass A, Eliakim R, Magro F, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 1: definitions and diagnosis. J Crohns Colitis. 2012; 6:965–990.

25. Dignass A, Van Assche G, Lindsay JO, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: current management. J Crohns Colitis. 2010; 4:28–62.

26. Riddell RH, Goldman H, Ransohoff DF, et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol. 1983; 14:931–968.

27. Gallinger ZR, Rumman A, Murthy SK, Nguyen GC. Perspectives on endoscopic surveillance of dysplasia in inflammatory bowel disease: a survey of academic gastroenterologists. Endosc Int Open. 2017; 5:E974–E979.

28. Choi CH, Rutter MD, Askari A, et al. Forty-year analysis of colonoscopic surveillance program for neoplasia in ulcerative colitis: an updated overview. Am J Gastroenterol. 2015; 110:1022–1034.

29. Marion JF, Waye JD, Israel Y, et al. Chromoendoscopy is more effective than standard colonoscopy in detecting dysplasia during long-term surveillance of patients with colitis. Clin Gastroenterol Hepatol. 2016; 14:713–719.

30. Hlavaty T, Huorka M, Koller T, et al. Colorectal cancer screening in patients with ulcerative and Crohn’s colitis with use of colonoscopy, chromoendoscopy and confocal endomicroscopy. Eur J Gastroenterol Hepatol. 2011; 23:680–689.

31. Rutter MD, Saunders BP, Wilkinson KH, Kamm MA, Williams CB, Forbes A. Most dysplasia in ulcerative colitis is visible at colonoscopy. Gastrointest Endosc. 2004; 60:334–339.

32. Rubin DT, Rothe JA, Hetzel JT, Cohen RD, Hanauer SB. Are dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis? Gastrointest Endosc. 2007; 65:998–1004.

33. Blonski W, Kundu R, Lewis J, Aberra F, Osterman M, Lichtenstein GR. Is dysplasia visible during surveillance colonoscopy in patients with ulcerative colitis? Scand J Gastroenterol. 2008; 43:698–703.

34. Iacucci M, Kaplan GG, Panaccione R, et al. A randomized trial comparing high definition colonoscopy alone with high definition dye spraying and electronic virtual chromoendoscopy for detection of colonic neoplastic lesions during IBD surveillance colonoscopy. Am J Gastroenterol. 2018; 113:225–234.

35. Freire P, Figueiredo P, Cardoso R, et al. Surveillance in ulcerative colitis: is chromoendoscopy-guided endomicroscopy always better than conventional colonoscopy? A randomized trial. Inflamm Bowel Dis. 2014; 20:2038–2045.

36. Jaramillo E, Tamura S, Mitomi H. Endoscopic appearance of serrated adenomas in the colon. Endoscopy. 2005; 37:254–260.

37. Spring KJ, Zhao ZZ, Karamatic R, et al. High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology. 2006; 131:1400–1407.

38. Hurlstone DP, Sanders DS, Lobo AJ, McAlindon ME, Cross SS. Indigo carmine-assisted high-magnification chromoscopic colonoscopy for the detection and characterisation of intraepithelial neoplasia in ulcerative colitis: a prospective evaluation. Endoscopy. 2005; 37:1186–1192.

39. Carballal S, Maisterra S, López-Serrano A, et al. Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD. Gut. 2018; 67:70–78.